Rationale

• Profile of U.S. population is changing
  • More non-caucasian populations in recent years
• Data exists showing health disparities within and between population groups
• Introduction of federal mandates (CLAS standards)

Diversity

• By 2050, half of the U.S. Population would be people of color
• Diversity goes beyond ethnic diversity and includes diversity as individuals
  • Culture
  • Religion
  • Mental or physical abilities
  • Age
  • Gender
  • Sexual orientation

Health Disparities

• Based on barriers to access and utilization of services
• Health outcomes including disability, disease, and death
• Poorer overall health
  • Barriers to optimal health include social, economic, and cultural factors
• Population specific differences result in gaps in the quality of health and health care across racial and ethnic groups
  • e.g. infant mortality in American Indians and Alaskan natives, cervical cancer in Vietnamese women, diabetes in Pima Indians of Arizona

Federal Mandates

• 2001 National Standards for Cultural and Linguistically Appropriate Services in Health Care (CLAS standards)
• Issued by the U.S. Department of Health and Human Services, Office of Minority Health
• 14 Standards composed of mandates, guidelines and recommendations, emphasizing:
  • Cultural competent care
  • Language access services
  • Organizational support for cultural competence

Definitions

• Race
  • Socio-political construct
  • Defines categories of people based on inherent physical characteristics
  • Categories not reflected on genetic level
    • Minimum Race/Ethnicity categories include: Native Americans/Alaskan, African American, Asian, Hawaiian/Pacific Islander, Caucasian, and Hispanic/Latino
• Ethnicity
  • Self-defined and relates to one’s identity with a group
  • Group can share common ancestry, religion, history, or culture
  • Can identify with multiple ethnicities
• Culture
  • Learned construct
  • System of beliefs, values, customs, artifacts, and behaviors that are learned and shared by members of a group
  • Transmitted from generation to generation
  • Individuals often embrace more than one culture at a time
• Generalizations
  • Starting point to identify common trends
  • More information need and sought to determine if the trend is appropriate for a specific individual
• Stereotypes
  • Ending points
  • No attempt is made to learn if the statement is appropriate for an individual
• Cultural Competency
  • Defined as a set of congruent behaviors, attitudes, and policies that come together in a system and enable functioning in cross-cultural situations

Cultural Competency

• Becoming comfortable with differences
• Acquiring the ability to control and change false beliefs and assumptions
• Respecting and appreciating the values and beliefs of those that are different
• Thinking flexibly
• Behaving flexibly

Requirements

• Skills
  • Specific to each group or culture
    • Credible communicator
    • Elicit patient’s view of illness
    • Recognize culture related problems
    • Cultural interpretation of behavior
    • Language proficiency or effective translator use
    • Application of epidemiological principles to common illness
• Knowledge
  • Aware of differences
  • Appreciate diversity
  • Concepts of race, culture, ethnicity, and power
  • Communication
  • Culture specific illnesses and behavior
• Attitudes
  • Recognize and accept differences
  • Cultural and individual assessment
  • Patient’s belief integration in health plan
  • Social and political context investigated and not dismissed
• Life Context
  • Family structure
  • Religion, death, and traditions
  • Prevailing psychosocial and political context of the group’s existence

LEARN Model

• Listen with sympathy and understanding
• Explain your perception of the problem and treatment strategy
• Acknowledge and explain differences
• Recommend treating remember patient’s cultural parameters
• Negotiate an agreement

Conclusions

• Concept of culturally competent care and its impact on delivery of health care
• The role of various stake holders
• Assess the problem and develop solutions
• Be better physicians and deliver better health care